The Causes, Symptoms, and Treatment of Vulvodynia

Vulvodynia is a chronic pain in the vulva, the exterior female genitalia. The pain or discomfort has no obvious cause and can affect the labia, clitoris, or vaginal opening.

The International Society for the Study of Vulvovaginal Disease defines vulvodynia as chronic vulvar discomfort or pain characterized by burning, stinging, irritation or rawness of the female genitalia. Chronic is defined as existing for at least three to six months.

Causes

The cause of vulvodynia remains unknown. It may be the result of multiple factors. Physicians speculate that it may be caused by an injury to or irritation of the nerves that supply and receive input from the vulvaa localized hypersensitivity to yeast; an allergic response to environmental irritants; high levels of oxalate crystals in the urine; or spasm and/or irritation of the pelvic floor muscles. There is no evidence that vulvodynia is caused by an infection or that it is a sexually transmitted disease.

Symptoms

Burning sensations are most common; however, the type and severity of symptoms experienced are highly individualized. Some women describe their pain as stinging irritation or rawness. Vulvodynia may be constant or intermittent, concentrated in one area or spread out.

The two major subsets of the condition: generalized vulvodynia and localized vulvodynia.Vestibulodynia is a specific kind of localized vulvodynia.

• Generalized vulvodynia is characterized by pain that is spread out throughout the vulvar region. It can be present in the labia majora and/or labia minora. Sometimes it affects the clitoris, perineum, mons pubis and/or inner thighs. The pain may be constant or intermittent, and it is not necessarily initiated by touch or pressure to the vulva. The vulvar tissue may appear inflamed, but in most cases, there are no visible findings.
• Localized vulvodynia is more common and the pain is at only one site, such as the vestibule. Women with vestibulodynia have pain when touch or pressure is applied to the vestibule ( the area surrounding the opening of the vagina). Women may experience pain with intercourse, tampon insertion, gynecologic exam, bicycle riding, horseback or motorcycle riding, and wearing tight clothing, such as jeans. Most often, the vestibule of women with VVS is inflamed and red.

Regardless of the type of vulvodynia a woman has, the disorder imposes serious limitations on a woman's ability to function and engage in normal daily activities. The pain can be so severe and unremitting that it forces women to resign from career positions, abstain from sexual relations, and limit physical activities. Not surprisingly, these limitations negatively affect a woman's self-image; many women become depressed because of the physical pain itself and the associated psychological and social implications.

Diagnosis

The diagnosis of vulvodynia is made by ruling out other conditions that can cause vulvar pain, such as sexually transmitted diseases, infections, skin disorders, and human papillomavirus. A patient's medical history needs to be reviewed carefully, and a complete vulvar and vaginal examination is necessary.

Culture is often taken from the vagina to rule out things like sexually transmitted diseases and infections. A "q-tip" test is often administered during the exam. During this test, different areas of the vulva and vestibule are touched with a cotton swab to determine the location and severity of a woman's pain.4

 If the doctor sees areas of skin that look suspicious during the exam, a biopsy of the skin may be required.

Additionally, physicians may recommend a colposcopy, a procedure that uses a specialized instrument to examine the vulva more closely.

Treatment

Because the cause of vulvodynia is not known, treatment is usually geared towards relieving symptoms and giving some measure of pain relief. Different treatments work better for different women, so several might be tried to find the one that works best for you. The types of treatments that might be tried include:5

• Removing irritants
• Oral pain-relieving medication
• Topical medications including hormone cream, topical anesthetics, and topical compounded medications
• Pelvic floor muscle therapy
• Neurostimulation
• Biofeedback
• Nerve block injections
• Surgery
• Complementary and alternative therapies

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Paraphimosis

Paraphimosis is a condition in which the foreskin becomes trapped behind the head of the penis and is unable to be pulled back into position over the head of the penis. It can cause pain, swelling of the head of the penis and the foreskin. It may also restrict blood flow, causing the head of the penis to become dark purple in color. If this should occur emergency treatment is required.2

Treatment

If the foreskin cannot be pulled back into place treatment should be sought. If the blood flow to the penis is restricted then emergency treatment is required and if the foreskin cannot be pulled back a surgical cut to the trapped foreskin may be required. Failure to seek treatment can result in permanent damage to the penis.

Hygiene and the Foreskin

The only person who should clean and retract the foreskin is the boy himself. Bubble bath products and other chemical irritants can cause the foreskin to tighten and it is recommended they should be avoided by intact males.

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Phimosis [When the foreskin won't retract]

Phimosis, or preputial stenosis, refers to any condition where the foreskin of the penis cannot be retracted. Most infants are born with a foreskin that cannot be retracted and the prepuce may be tight until after puberty.

Causes

Phimosis can be caused by the failure of foreskin to loosen during growth, infections such as balanitis, deformities caused by trauma, and diseases of the genitals.

Symptoms

Phimosis is usually a painless condition. Infection may result from an inability to carry out effective cleaning of the area, in which case swelling, redness, and discharge may all be present, making the area tender and painful. A very tight foreskin can cause problems during intercourse and urination.

Treatment

Medical opinion differs on the condition and on the treatment of phimosis. It has been suggested that any radical or surgical treatments for phimosis should not be done until after puberty. This is partly due to a perception of the overuse of circumcision as a mainstream treatment for phimosis. It has also been reported that significant numbers of doctors are unable to recognize developmentally normal tight prepuce from pathological phimosis. It is believed that many unnecessary circumcisions are performed because of current medical practice and misdiagnosis of phimosis.

Balanitis xeroticia obliterans has been cited as one of the only causes of phimosis that should lead to a surgical circumcision.

If treatment is required there are three main types:

• Tropical creams, steroidal and non-steroidal, applied to the prepuce.
• Gradual stretching of the opening of the prepuce to widen it.
• Surgical reshaping of the prepuce to make it wider.

All these treatments tend to avoid the side effects associated with surgical circumcision, trauma, pain, side effects of the removal of the foreskin such as friction and interference of the erogenous and sexual functions

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diagnosis and treatment af penile fracture

Diagnosis

An initial diagnosis of penile fracture is often from a description of how the injury occurred. If the circumstances and appearance are what would be expected from a penile fracture, it probably is one. However, further exploration is generally necessary to determine the location and extent of the injury. It is important, for example, for doctors to determine whether the urethra has been injured. That could require surgical repair.

Either ultrasound or MRI can be used to map out an injury to the penis that is thought to be a penile fracture. These techniques can be used to detect whether the urethra has been torn or damaged. They can also be used to identify other concerns such as injury to the arteries and veins of the penis.

Treatment

Immediate surgical repair is the standard treatment for penile fracture. A 2016 meta-analysis found that men who had surgery after a fracture were significantly less likely to have long-term problems than those whose fractures were managed more conservatively. There is less of a consensus about whether surgery needs to happen immediately or if it can be delayed up to 24 hours.

Surgery recovery time varies significantly, depending on the type of fracture and the specific surgical procedure. Men may be in the hospital for anywhere between one day and three weeks.

Fortunately, only a small fraction of men with penile fractures experience significant complications after surgery. The 2016 meta-analysis, which included 58 studies of more than 3,000 patients, found that fewer than 2 percent of men who had surgery for penile fracture experienced long-term erectile dysfunction. In addition, less than 3 percent experienced permanent curvature of the penis. Those numbers were significantly higher (22 and 13 percent respectively) for men whose penile fractures were managed more conservatively.

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Penile Fracture and causes

Among the phrases that men dread to speak, "I broke my penis," is likely near the top of the list. Fortunately, penile fractures are a relatively rare occurrence. They mostly occur in young men, and they mostly occur during intercourse. However, they can occur at other times. For example, a penile fracture can be the result of a fall or other trauma to the erect penis.

In some ways, the term penile fracture is a confusing one. Most people associate the world fracture with the breaking of a bone. The penis is not a bone, but technically a fracture is a break in any hard material. Penile fractures usually occur when the penis is erect, for reasons that will be explained below.

How Does a Penile Fracture Happen?

The erectile structures of the penis work similarly to an inflatable pump. The penis contains two large tubular structures known as the corpus cavernosum. These are surrounded by a strong, thick membrane known as the tunica albuginea, or tunica. When the penis becomes erect, the corpus cavernosa fill with blood and become rigid, like balloons filling with water. There is also a third tube, the corpus spongiosum, that surrounds the urethra. The broad tip of that tube is the penile glans. However, this tube is much smaller than the corpous cavernosa and holds only a small fraction of the blood present in the penis during an erection.

The tunica albuginea is an incredibly strong membrane. It has to be, in order to contain the blood that holds the penis erect. However, it can still be broken or ruptured. A ruptured tunica albuginea is also known as a penile fracture.1 Penile fractures happen more frequently during erections because, just as with a balloon being inflated, the tunica stretches and thins as the penis becomes erect. This makes it more vulnerable to a penile fracture.

Causes

Penile fractures most often occur during vigorous intercourse. It is generally believed that the most common position where these fractures occur is in the woman on top position, although there is no good data to support this. However, penile fractures can also occur during intercourse in other positions. In addition, penile fractures can occur during vigorous manipulation of the penis, such as forceful masturbation. They can also be caused by trauma, including from aggressive bending of the erect penis or by rolling over onto the erect penis.

At the time a penile fracture occurs, there is usually a cracking sound. It is sometimes described as similar to breaking glass. Then the penis quickly loses its rigidity. This detumescence is quickly followed by swelling and bruising, leading to the classic eggplant deformity.Other injuries to the arteries and veins of the penis can lead to similar symptoms.

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